Flashcards in General cardiac Deck (63):
what is aortic coarctation? What are some physical signs you would look for if a patient had aortic coarctation?
Narrowing of the aortic arch distal to the left subclavian artery. Congenital cause. Some physical signs include: radio femoral delay, increased blood pressure, scapular bruit, systolic murmur over the scapula (L)
what can a radio femoral delay indicate?
aortic coarctation or aortic dissection
What does the TIMI score indicate?
For NSTEACs it calculates the risk
1. Age > 65 years
2. Greater than 3 CAD risk factors
3. Stenosis > 50%
4. Aspirin use in the past 7 days
5. 2 episodes of angina in last 2 days
6. ECG ST changes > 0.5 mm
What branches come off the left circumflex artery?
Obtuse marginal branches
what branches come off the right coronary artery?
acute marginal branches
what branches come off the left anterior descending artery?
what branches come off the left anterior descending artery?
what are some complications of a myocardial infarct?
Rupture--> tamponade, MR due to papillary muscle rupture, arrhythmias like VT and heart block, acute heart failure --> APO, pericarditis and reinfarction with another plaque.
What 6 clinical features do we see in a ruptured AA aneurysm?
2. Sudden onset of abdominal pain
3. Look for a pulsatile mass in abdominal
4. Features of progressive hypovolemia
5. HR may not be a feature in older people bc of beta blockers etc.
6.Some people may become unconscious/obtundant.
what is an aneurysm?
• Focal dilatation of the artery
• 1.25 greater diameter than adjacent normal artery
-Weakness in elastin and collagen in the adventitia and media.
what do you see in proximal inflow aorto/iliac lower limb occlusive disease?
(claudication in the calf,+ thigh + buttock. You would expect the femoral pulse to be reduced or absent and there might be a bruit over the aorta/iliac)
what clinical features would you see in femoral/popliteal lower limb occlusive disease?
(claudication in the calf. Reasonable femoral pulse, weak or absent popliteal and pedal pulse. Bruit may be heard over the femoral or popliteal arteries.
What clinical features would you see in talo-crural lower limb occlusive disease?
(no claudication. Popliteal and pedal pulses may be reduced. Gangrene in foot may be present. Rest pain may be a feature. Popliteal bruit may be present)
what is the clinical diagnosis of claudication? where do you mostly see it?
Clinical diagnosis- calf pain on exertion +/- thigh; +/- buttock. Onset and severity is related to workload. It is relieved by rest and is reproducible. mostly seen in posterior calves
What is the WHO definition of MI
1. Symptoms of myocardial ischaemia (SOB, chest pain etc)
2. Elevation of cardiac markers (troponin or CK)
3. Typical electrocardiographic pattern involving the development of Q waves, ST segment changes or T wave changes
what is the usual post hospital management of a MI?
• Modify cardiac risk factors (diabetes, cholesterol levels, hypertension)
• Medication compliance
• Modify lifestyle
• Follow up- review at 1 month, then 6 months thereafter. Repeat echo at 6 months
Stress testing at 1 year
what are some procedural ways we can manage AF?
-AV node ablation and pacemaker insertion
-Radiofrequency catheter ablation of arrhythmogenic foci in atria, usually found around pulmonary veins
-Surgical maze procedure
-Internal atrial defibrillators
-Obliteration of left atrial appendage.
what are the 3 types of cardiomyopathy? what kind of pathologies do they cause?
1.hypertrophic, 2. restrictive, 3. dilated
Hypertrophic/restrictive= poor diastolic function
dilated= poor systolic function
what are some causes of dilated cardiomyopathy?
toxins like alcohol, myocarditis, post partum, genetic inheritance of mutated muscle proteins like titin, pheochromocytoma, and haemachromatosis
what bacteria is associated with rheumatic heart fever?
what causes new onset AF?
• Ischaemic heart disease (ACS)
• Rheumatic heart disease/ valvular disease
• Thyroid disease
• Electrolyte disorders
what is the significance of type A vs Type B aortic dissection?
Type A- consider for surgery whereas type B- medical management
what is Dressler's syndrome?
Pericarditis as a complication of myocardial infarction. Symptoms are fever, pleuritic chest pain, pericarditis and pericardial effusion
Pathophys: autoantibodies against the heart muscle
what valvular disease would you expect to cause displacement of the apex?
Aortic regurgitation, mitral regurgitation
What are the 4 parts to a tetralogy of Fallot congenital heart disease?
1. VSD (ventricular septal defect)
2. Right ventricular hypertrophy
3. Pulmonary artery stenosis
4. Overriding aorta
what are the 3 criteria for STEMI?
3 criteria for STEMI:
1. ST elevation > than 2 mm in V1-V6
2. ST elevation > 1mm in the limb leads
3. New LBBB
(any one of these= STEMI)
which leads do we look for an anterolateral infarct?
LCx artery- V5, V6, I and aVL
which leads on ECG do we look for an anteroseptal infarct?
LAD artery- V1-V4
which leads on ECG do we look for an inferior infarct?
RCA artery- II, III, aVF
what are the 5 steps for reading an ECG?
1. Rate and rhythm
3. QRS (+ BBB)
5. QT intervals
what is prinzmetal angina, and how does it differ from typical angina?
Prinzmetal angina is caused by vasospasm of the coronary arteries as compared to an atherosclerotic plaque. Generally distinguished by exercise stress test- prinzmetal angina is exercise tolerant.
what murmurs decrease/increase with valsalva manoeuvre?
All murmurs decrease except for HOCM systolic murmur which increases with valsalva manoeuvre
what do you think if you see global low voltage ECG?
Cardiomyopathy or a pericardial effusion
What is pericarditis? how do we normally manage this?
Inflammation of the pericardial tissue. Pericardiocentesis if tamponade on the heart, or medical management- NSAID, colchicine, PPI
when do you get a parasternal heave during cardiovascular examination?
right ventricular hypertrophy or cor pulmonale
what constitutes Unstable Angina?
• New onset angina
• Angina becoming more frequent and severe
• Angina at rest >20mins
-Post MI angina
what does hypertension do to the MAP graph?
shifts to the right
tell me the pathophysiology of CCF? (refer to frank starling mechanism)
• As CO drops due to heart failure, the body must compensate to increase End diastolic pressure as defined by the Frank Starling Curve.
• If EDV is increased, then the heart will contract harder and increase CO
• The baroreceptor reflex detects the drop in CO and this leads to sympathetic activation of Renin angiotensin system that increases vasoconstriction and fluid retention via aldosterone secretion.
Overtime the heart decompensates and fluid retention becomes third spacing, manifesting as oedema in the ankle and signs of fluid overload.
what are some precipitants of heart failure?
• Ischaemic heart disease
• Valvular heart disease
• Hypertensive heart disease
• Congenital heart disease
• Cor pulmonale
which valve is associated with IVDU infective endocarditis?
tricuspid valve usually
what clinical signs indicate sustained hypertension?
Hypertensive retinopathy - AV nipping
fever + murmur?
is infective endocarditis unless proven otherwise
what is kussmaul's sign relating to the JVP
JVP rises with inspiration= kussmaul's sign. This indicates constrictive pericarditis
what does a S4 heart sound indicate? when does it occur?
turbulence during stiff atrial contraction- occurs before S1
-associated with AS or HOCM
what does a S3 heart sound indicate?
turbulence during early filling of ventricle.
-associated with aortic regurgitation or mitral regurgitation
what are the 5 manoeuvres which can affect the intensity of heart murmurs?
1. Inspiration/Expiration (Left vs Right sided)
2. Deep expiration, lean forward (AR)
3. Valsalva (HCM)
4. Standing to squatting
5. Isometric exercise
name the 3 types of pan systolic murmurs?
Ventral septal defect
what type of murmur is atrial septal defect?
mid systolic murmur
what causes a late systolic murmur?
mitral valve prolapse
what type of murmur is a patent ductus arteriosus?
what do we mean by a flow murmur?
an innocent murmur often due to anaemia or thyrotoxicosis
what do you think when you have a quadruple heart sound murmur?
severe ventricular dysfunction
pathogen associated with rheumatic fever?
group A strep- strep pyogenes
what are some other features of rheumatic fever besides the murmur?
rash erythema marginatum
subcutaneous nodules over elbows
what sort of HS reaction is rheumatic fever?
type 2 (antibody cross reactivity)
where do we find rheumatic fever?
how do we calculate ejection fraction?
what are some clinical features of AS?
SOB and chest pain on exertion
slow upstroke pulse
ejection systolic murmur on R sternal edge
radiates to carotids
is the apex beat displaced in AS?
not usually. causes concentric hypertrophy
what are some causes of aortic regurgitation?
aortic valve damage due to endocarditis
aortic valve dilation due to marfans
when do we begin surgery for aortic regurgitation?
Echo criteria of LVH and LV dysfunction is the main indication for surgical intervention
some causes of MR?
myxomatous mitral valve degeneration